UR-CHOICE: can we provide mothers-to-be with information about the risk of future pelvic floor dysfunction?
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Vaginal childbirth is probably the most important factor in the aetiology of pelvic floor dysfunction (PFD) and results in the combination of some or all of the following conditions: urinary (UI) and faecal (FI) incontinence and pelvic organ prolapse (POP). Up until now, it has been difficult to counsel women antenatally regarding risk factors for subsequent PFD, as there has been little good-quality, long-term information available. We now have moderately robust epidemiological data at 12 and 20 years after delivery and objective pathophysiological data (pudendal nerve trauma and levator defects/avulsion). In this commentary, we propose a scoring system (UR-CHOICE) to predict the risk of future PFD based on several major risk factors (UI before pregnancy, ethnicity, age at birth of first child, body mass index, family history (mother and sister) of PFD and baby’s weight and maternal height (if <160 cm and baby >4 kg) that have been identified for subsequent PFD risk. This scoring system will help with counselling for women regarding PFD prevention.
KeywordsPelvic floor dysfunction Urinary incontinence Faecal incontinence Pelvic organ prolapse Vaginal delivery Caesarean section Prediction
Professor Bob Freeman was partially funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West of England. The views expressed in this publication are those of the author and not necessarily those of the NHS, the NIHR or the Department of Health.
Professor Cathryn Glazener, Professor of Health Services Research, Health Services Research Unit University of Aberdeen and Jean Hay-Smith Associate Professor Dunedin School of Medicine, University of Otago, New Zealand for their comments and advice on the manuscript.
Conflicts of interest
Professor Ian Milsom: Speaker fees at educational meetings sponsored by Astellas, Pfizer and SCA. Professor Bob Freeman: Speaker fees at educational meetings sponsored by Astellas and Pfizer
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